Integrating Existential and Narrative Therapy: A Theoretical Base for Eclectic Practice

1. Theory in Psychotherapy

1 1 Theory in Psychotherapy THEORY AS A GUIDE Meeting with new clients for the first time can be overwhelming, even for seasoned therapists. So much is happening. There are the stories clients tell about their concerns and problems, typically containing many different scenarios and emotional reactions. There are the ways they tell the stories—all the various paralinguistic elements of the verbal presentation which suggest an array of emotions accompanying the telling of the story. There are the ways clients look, how they position themselves in the space of the consulting room, the gestures they use—or do not use. There are the thoughts, emotions, utterances and physical actions of the therapists, all elements in this stew. What out of all of this should be attended to? How should various bits of information be linked together to arrive at some understanding of this individual’s concerns and psychological functioning? And what should the therapist do in order to be helpful to the client? To begin to deal with the mass of information and the myriad conceptual and procedural questions inherent in any meeting with a client , therapists (and clients) need a guide. A theory of psychotherapy is such a guide. Although the therapist, one hopes, has a more differentiated and better articulated theory of psychotherapy, the client will always have one as well. It is most helpful if their guides are similar. TWO TYPES OF THEORIZING Every theory rests on a set of ontological and epistemic assumptions that are rarely articulated in the theory. However, these assumptions 2 Integrating Existential and Narrative Therapy are important in understanding any theory, and it is useful to begin with a brief examination of two distinct sets of assumptions underlying theories of psychotherapy. A Realist Perspective Historically, psychological theories, including theories of therapy, have striven to be “scientific,” rooted in a realist ontology, a fundamental belief in a “real” world that exists independent of human attempts to know that world. The scientific methodology that emerged from that ontological stance and the epistemology that follows from it have been positivist. This view has dominated scientific thinking and research for many centuries and only began to be seriously challenged late in the twentieth century. It is, therefore, a way of thinking that is familiar to most, and one which I will use as a starting point. Thinkers operating from a realist ontology often refer to a theory as a “map” of the “territory”—a limited and two dimensional representation of the complex reality that actually exists. A theory is understood as a set of conceptual tools, ways of thinking that assist people in understanding a phenomenon and acting in ways that will, presumably, help them achieve desired goals in relation to that phenomenon , whether those goals are advancing knowledge through basic research, engineering safer automobiles, sending people to the moon or promoting change in psychotherapy. Working within this realist/positivist tradition, Rychlak (1968) defines a theory as a set of constructs and the relational propositions linking those constructs. In other words, a theory defines the various components of the phenomenon of interest (constructs) and proposes connections among them (relational propositions) in an attempt to arrive at an explanation of the phenomenon. Applied to the realm of psychotherapy, such explanations of the origins of dysfunction and of the processes of change can help therapists know what to focus upon and how to make informed choices about how to assist clients. Rychlak (1968) argues that there are four specific ways in which a theory helps a person achieve understanding. A theory must first describe the phenomenon of interest. This sounds deceptively simple, as if one would “simply observe” and report what’s there. However, it is actually quite a complex process. First, what one observes is Theory in Psychotherapy 3 always shaped by one’s existing cognitive framework. Second, the act of describing requires that the observer make judgments regarding which differences (of those seen) are important and which are not. In describing a fish, does color matter? Typically, yes; but what about those fish that can change color? The point here is that description is a very human activity, not merely a straightforward “reporting.” These descriptions, these human choices regarding which differences count, result in groupings of observations which are the constructs of the theory. For example, anxiety is typically defined as a grouping of observations of heightened autonomic arousal, personal reports of apprehension...